1 / 33

GENERAL MEDICAL SERVICES

GENERAL MEDICAL SERVICES. GENERAL PRACTICE MANAGEMENT. Learning Outcomes. UNDERSTAND: The Scope of General Practice Management The various means by which GPs are contracted Key features of the Contractual and Partnership Agreements and the Business Plan

derora
Download Presentation

GENERAL MEDICAL SERVICES

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. GENERAL MEDICAL SERVICES GENERAL PRACTICE MANAGEMENT

  2. Learning Outcomes UNDERSTAND: • The Scope of General Practice Management • The various means by which GPs are contracted • Key features of the Contractual and Partnership Agreements and the Business Plan • General Practice funding streams

  3. Important History of General Practice 1948: Lord Beveridge, NHS is established, providingfree health care for everyone 1952: College of General Practitionersis founded 1966: Family doctor charter facilitates paymentsfor nursing staff and buildings 1976: Primary Care Act requiresgeneral practice principals to do vocational training Mid 80s: Cost /Notional Rent Scheme, Practice Nurses and Practice Managers started to appear 1990:General practice contract – Health Promotion Clinics. Fundholding introduced 1997: New contractenables general practitioners to choose to be salaried rather than self employed Personal Medical Services. Money ran out 1999: Fundholding is replaced by PrimaryCare Groups and Trusts 2004: nGMS Contract - Doctors are allowed to stop providingout of hours care

  4. Private trader at Work Before the 20th century general practitioners worked as private traders, treating patients only if they had the means to pay

  5. Yesterday v Today 2 groups

  6. GENERAL PRACTICE IS A BUSINESS General Practice is a small people-centred business The business is owned by the practice partnership GPs are “independent contractors”

  7. WHAT DO YOU EXPECT THE PRACTICE MANAGER TO KNOW AND BE CAPABLE OF DOING?

  8. NES GPMVTS MENU for LEARNING LEARNING NEEDS ANALYSIS D General Medical Services Contract (2003) Annex C: Competency Framework For Practice Management • Practice Operation and Development • Risk management and assessment • Partnership Issues • Patient and Community Service • Finance • Human Resources • Premises and Equipment • IM&T • Population Care

  9. “IN A TIME OF TURBULENCE AND CHANGE, IT IS MORE TRUE THAN EVER THAT KNOWLEDGE IS POWER” Sir Francis Bacon and J F Kennedy

  10. IMPORTANT DOCUMENTS to know about and use • Practice GMS Contract • Statement of Fees and Entitlements (SFE) • NHS Circulars • Partnership Agreement

  11. GENERAL PRACTICE CONTRACTING ARRANGEMENTS LOCAL ADMINISTRATION LEVEL: • Scotland – PCO - Primary Care Organisations • England - PCT - Primary Care Trusts • Wales - HB - Local Health Boards 4 CONTRACTUAL METHODS: • General Medical Services Contract (GMS) – (a new GMS contract has been in place since April 2004) • Personal Medical Services agreements (PMS) • Alternative Provider Medical Services (APMS), and • Primary Care Led Medical Services (PCTMS).

  12. A CONTRACT BETWEEN WHOM? • Contract between a practice and a PCO • all practice partners will enter contract with PCO • Individual practice contractual terms come from national “menu”

  13. A PARTNERSHIP AGREEMENT • A contract between the partners and should be kept up to date at all times in order to be valid and thus effective. • Although an oral partnership is a valid one, it is not to be recommended. • In a PARTNERSHIP AT WILL, relations between partners are governed by the Partnership Act 1890, unless some agreement to the contrary can be proved. • The Partnership Act was designed to cover all partnerships and does not meet the specific needs of individual professions.

  14. Partnership Act 1890.Some consequences of being a partnership 'at will'; • Any partner may dissolve it at any time with no formal procedure • Death or bankruptcy of a partner will automatically dissolve the partnership • No partner(s) has the right to expel another for any reason  • No partner(s) has the automatic right to carry on the partnership • The assets will be frozen immediately on dissolution • Staff will be made redundant on dissolution • All partners are entitled to an equal share of the assets  • All partners have equal liability for the debts • No new partner may be appointed without a unanimous decision • All partners may take part in the management of the partnership

  15. Partnership Agreements

  16. Document Hierarchy

  17. GMS CONTRACTPractice Based Lists • Patients Registered with Practice not GP • New Patient Right to See GP of Choice • Wait longer • New Rules on Registering Patients • Clinician can refuse (violent patient) • Refer to another clinician if doesn’t provide service • New Rules Removing Patients

  18. WHO are our PATIENTS? Must provide primary medical services to the following: REGISTERED PATIENTS & TEMPORARY RESIDENTS • provide appropriate ongoing treatment/care • including provision of advice re patients health (including health promotion) and referral to other services.

  19. IMMEDIATE NECESSARY TREATMENT Must also provide primary medical services required in core hours for any person (to whom the practice has been requested to provide treatment) owing to accident or emergencyat any place in practice area This includes any medical emergency not just services provided under this contract.

  20. THE CONTRACT “MENU”FIVE TYPES OF SERVICE “Normal” services: • Essential • Additional “ Supplementary” services: • Directed Enhanced • National Enhanced • Local Enhanced

  21. ESSENTIAL SERVICES - MANDATORY Practices must provide the followingservicesduring core hours (8am-6.30pm) Management of its registered patients & temporary residents (TR) who are: (a) ill, or believe themselves to be ill, with conditions from which recovery in generally expected (b) terminally ill (c) suffering from chronic disease delivered in the manner determined by the practice in discussion with the patient.

  22. ADDITIONAL SERVICES • Normally expected of all practices but OPT-OUT possible • These will mainly include services which are preventative: • CHS • Non-IUD contraception • Non-intra partum maternity • Childhood vaccinations and immunisations • Cervical screening • Curettage, cautery and cryocautery

  23. OPTING-OUT Either: • temporary (emergencies) • permanent (long-term problems) PCOs and practices working together Maximum 9-month process Alternatives – other practices, PCO, other providers e.g. walk-in centres Money removed from practice global sum Patient access to services protected LIST CLOSURE process

  24. DIRECTED ENHANCED SERVICES • OPT-IN for practice • Obligatory for each PCO • National specifications • No one practice has to do but someone has to • Services to violent patients • Childhood vaccinations and immunisations financial incentives • Minor surgery • Flu immunisations

  25. NATIONAL ENHANCED SERVICES OPT-IN - national terms and conditions e.g. Anticoagulant monitoring IUCD Sexual health MS Drug and alcohol misuse Terminally ill Depression Learning disabilities Intra partum care Minor injuries Near-patient testing Homeless Immediate/first response care

  26. LOCAL ENHANCED SERVICES OPT-IN • Response to specific local requirements • Local terms, conditions and standards • Possibly, innovative services for piloting and evaluation

  27. Seniority & Other Payments eg maternity, sickness Quality & Outcome Framework Enhanced Services Global Sum or Minimum Practice Income Guarantee PaymentsHow can the practice income be increased? 3

  28. GLOBAL SUM UNIFIED BUDGET QOF - ASSURED QUALITY MONEY ESSENTIAL & ADDITIONAL PROTECTED TIME PCO-MANAGED FUNDS LOCAL ENHANCED DIRECTED AND NATIONAL ENHANCED PCO PREMISES GUARANTEED FUND(S) £ IT ALTERNATIVE PROVIDER PRACTICE

  29. 2011-2012 GMS CONTRACT AGREEMENT Practice Expenses For 2011-12, in order to reduce the risks of a further net pay cut for GPs, we have agreed to an increase to the overall value of GMS contract payments by 0.5 per cent, to support practices in meeting the costs of increased expenses, including the pay award for employed staff with a full time equivalent salary of less than £21,000. This increase will be delivered in through a 2.53 per cent increase in the value of a QOF point from £127.29 to £130.51. This increase in the value of a QOF point is intended to deliver the full 0.5 per cent expenses increase agreed with NHS Employers. Increased expenses – no reimbursement for Commercial waste disposal

  30. BUSINESS PLANNING“Alice's Adventures in Wonderland” Alice comes to a fork in the road and asks the cat: • “Would you tell me, please, which way I ought to go from here?” • “That depends a good deal on where you want to get to”, said the Cat. • “I don't much care where”, said Alice. • “Then it doesn't matter which way you go”, said the Cat. Rudderless, haphazard, reactive, poor communication and teamwork

  31. BUSINESS PLAN Needs: • People – Personnel & Patients • Organisational • Operational Plan: • Vision and the Mission • Practice Profile • Running the Business • Finance

  32. ACTIVITYThe Practice Merger • The Task • In groups of 5-6, consider the scenario • Before commencing the exercise, nominate a spokesperson and a scribe. • You have 20 minutes to brainstorm the issues • You are not expected to solve the problems but to identify the issues • The issues may be suitable tutorial topics

More Related